Browse publications by year: 2019

  1. Sattar, Kamran
    MyJurnal
    Professionalism is considered as one of the most inspiring as well as challenging proficiency to teach and evaluate, because of its multifaceted and context-specific nature. This paper defines an orderly and useful escort on how to incorporate the problem-based learning (PBL) as a teaching and assessing modality, within a course of medical professionalism. While answering Harden’s 10 questions, course planners shall find this approach doable, allowing them to design and utilising this in an undergraduate medical education context. An enlightening approach, as this will prepare our students to be future professional doctors, equipped with all necessary professionalism attributes, in our fast varying professional environment.
  2. Fahisham Taib
    MyJurnal
    Disease trajectory in children can be difficult to determine. This is primarily, despite the life limiting condition, healthcare professionals are unable to pin the exact time when these children’s lives will end. We illustrate an unusual case of dicephalic parapagus, an inseparable conjoined twin which was complicated by anomalies, psychosocial and safeguarding issues. Such case posed a challenge even to paediatric palliative care team as the trajectory of the disease, in this case, is rather difficult to predict. Anticipatory symptoms management perhaps is the best way forward, despite having to face many ethical challenges and medical enigma.
  3. Lili Husniati Yaacob
    MyJurnal
    This case illustrates the issue of truth-telling about a diagnosis of a potentially terminal illness. A family member of an elderly patient requests that the treating doctor does not disclose the diagnosis to the mother for fear that it will distress her and cause her anxiety. The challenge of the treating doctor is how to deal with this in a professional and ethical manner.
  4. Sattar, Kamran, Sethi, Ahsan, Akram, Ashfaq, Ahmad, Tauseef, John, Jennesse, Muhamad Saiful Bahri Yusoff
    MyJurnal
    The flipped classroom (FC), an innovative teaching and learning pedagogy has grown in medical education since last decade. In FC modality, students learn by means of print, audio or video-based material self-reliantly, before built-in teaching sessions in the classroom to overcome passive learning. In this review, the key concepts, benefits and best practices of the FC in health professions education have been described. The review was carried out using Medline, Scopus, Ovid, and Cochrane. The keywords were “Flipped method, Teaching strategy, Role of the teacher, and Medical students”. Flipped is an effective teaching modality which enables learners to be independent. Students do take ownership of what they learn. Tutors are also satisfied with what their learners acquire. The benefits of FC are robust and likely to augment the learning abilities of the students as well as supplementing the learning course content; group events can deliver added benefits too.
  5. Prayongratana K, Viprakasit V
    Blood Cells Mol. Dis., 2019 11;79:102347.
    PMID: 31323480 DOI: 10.1016/j.bcmd.2019.102347
    MeSH terms: Acute Disease; Elliptocytosis, Hereditary/genetics*; Glucosephosphate Dehydrogenase Deficiency/genetics*; Hemolysis/genetics*; Humans; Thailand; Inheritance Patterns
  6. Mortell M
    Br J Nurs, 2019 Nov 14;28(20):1292-1298.
    PMID: 31714835 DOI: 10.12968/bjon.2019.28.20.1292
    This article employs a paediatric case study, involving a 3-year-old child who had an anaphylactic reaction that occurred as a result of the multidisciplinary team's failure to identify and acknowledge the patient's documented 'known allergy' status. It examines and reconsiders the ongoing healthcare dilemma of medication errors and recommends that known allergy status should be considered the second medication administration 'right' before the prescribing, transcribing, dispensing and administration of any drug. Identifying and documenting drug allergy status is particularly important when caring for paediatric patients, because they cannot speak for themselves and must rely on their parents, guardians or health professionals as patient advocates. The literature states that medication errors can be prevented by employing a 'rights of medication administration' format, whether that be the familiar '5 rights' or a more detailed list. However, none of these formats specify known allergy status as a distinct 'right'. The medication safety literature is also found wanting in respect of the known allergy status of the patient. When health professionals employ a medication administration rights format prior to prescribing, transcribing, dispensing or administering a medication, the 'known allergy status' of the patient should be a transparent inclusion.
    MeSH terms: Child, Preschool; Drug Hypersensitivity*; Humans; Medication Errors/adverse effects; Medication Errors/prevention & control*; Safety Management/methods*; Patient Safety*
  7. Dadrasnia A, Usman MM, Abutawila Z, Omar R, Ismail S, Abdullah R
    J Environ Health Sci Eng, 2019 Dec;17(2):571-579.
    PMID: 32030135 DOI: 10.1007/s40201-019-00371-0
    Arsenic is a global environmental contaminant that imposes a big health threat which requires an immediate attention to clean-up the contaminated areas. This study examined the biosorption ability of a novel Bacillus strain for the removal of arsenate (pentavalent arsenic) from aqueous solution. The optimum biosorption condition was studied as a function of biomass dosage, contact time and pH. Dubinin-Radushkevich (D-R), Freundlich, and Langmuir models were applied in describing the biosorption isotherm. The maximal biosorption capacity (92%) was obtained at 25 °C, biomass concentration 2000 mg/L at pH value of 4 and contact period of 50 min. Strain 139SI act as an admirable host to the arsenate. Thermodynamic assessment (ΔG0, ΔH0, and ΔS0) also suggested the chemisorption and feasible process of As(V) biosorption. The reuse study illustrated the highest recovery of 93% using 1 M HCl, and a decrease of 25% in recovery of As(V) ions after 10 times desorption process.
  8. Ahmad A, Ghufran R, Al-Hosni TK
    J Environ Health Sci Eng, 2019 Dec;17(2):1195-1203.
    PMID: 32030185 DOI: 10.1007/s40201-019-00434-2
    To investigate the interaction of zinc oxide nanoparticles (ZnO NPs) with fly ash soil (FAS) for the reduction of metals from FAS by Parthenium hysterophorus were studied. The average accumulation of metals by P. hysterophorus stem were Fe 79.6%; Zn 88.5%; Cu 67.5%; Pb 93.6%; Ni 43.5% and Hg 39.4% at 5.5 g ZnO NP. The concentration of ZnO NP at 1.5 g did not affect the metals accumulation, however at 5.5 g ZnO NP showed highest metal reduction was 96.7% and at 10.5-15.5 g ZnO NP of 19.8%. The metal reduction rate was R
    max
    for Fe 16.4; Zn 21.1; Pb 41.9; Hg 19.1 was higher than Ni 6.4 and Cu 11.3 from the FAS at 5.5 g ZnO NP whereas, the reduction rate of Pb showed highest. With doses of 5.5 g ZnO NP the biomass increased upto 78%; the metal reduced upto 98.7% with the share of 100% ZnO NP from FAS. Further investigation with phytotoxicity the plant reactive oxygen species (ROS) production were affected due was mainly due to the recovery of metals from FAS (R2 = 0.99).
    MeSH terms: Lead; Mercury; Soil; Zinc; Zinc Oxide; Reactive Oxygen Species; Biomass; Asteraceae; Nanoparticles; Coal Ash
  9. Krishnasamy S, Sahid SM, Hashim SA, Singh S, Chung F, Mokhtar RAR, et al.
    J Thorac Dis, 2019 Dec;11(12):5453-5462.
    PMID: 32030264 DOI: 10.21037/jtd.2019.11.44
    Background: Obstructive sleep apnea (OSA) is a serious health disorder which contributes to cardiovascular complications, decreased work productivity, automobile accidents, and death. This condition is characterized by a temporary cessation of breathing resulting due to upper airway closure during a person's sleep. Strain to the heart caused by this repetitive hypoxic insult can lead to postoperative complications for patients undergoing heart surgery. Recognizing cardiac surgical patients with OSA is important. Early recognition and intervention such as use of BiPAP device can reduce the postoperative complications due to OSA.

    Methods: The aim of this study is to identify the incidence of unrecognized OSA in cardiac surgical patients. This is a retrospective analysis of a prospective data of the study which was done between July 2012 and July 2013 in University Malaya Medical Center. All patients undergoing elective cardiac surgery were recruited and the demographic data, questionnaire and the portable sleep study results were obtained. Patients were followed up till 30 days to record any complications. Data were entered in SPSS version 17 and analysis was done.

    Results: The incidence of OSA was 61.4% and 43.5% were moderate to severe OSA. There was male predominance of OSA (79%) with a mean age of 60 years. OSA subjects had shorter inter-incisor distance (4.18±0.6 cm) and larger waistline (94.1±12.1 cm). The STOP-Bang questionnaire has a sensitivity of 75.8% in predicting apnoa-hypopnea index (AHI) ≥5/hour.

    Conclusions: OSA can be diagnosed with a simple screening questionnaire and a bedside portable sleep study. Cardiac patients diagnosed with OSA can be pre-emptively given extra attention in managing their postoperative care.

  10. Susilowati H, Artanto S, Yulianto HDK, Sosroseno W, Hutomo S
    F1000Res, 2019;8:1008.
    PMID: 32025288 DOI: 10.12688/f1000research.19327.2
    Background: Pyocyanin (PCN), a highly pathogenic pigment produced by Pseudomonas aeruginosa, induces caspase 3-dependent human B cell (Raji cells) death. The aim of the present study, therefore, was to assess whether antigen-specific IgY antibodies may be protective on PCN-induced Raji cell death. Methods: Chickens were subcutaneously immunized with Freund's complete adjuvant containing PCN, and then given two boosted immunizations.  Anti-PCN IgY antibodies were purified from egg yolk and detected using an agar gel precipitation test (AGPT) and ELISA. Protective effects of antigen-specific IgY on Raji cells were tested using a cell viability assay. Results: AGPT results showed the formation of strong immune complex precipitates, whilst ELISA further confirmed the presence of IgY antibodies specific to PCN at significant concentration. Further experiments showed that anti-PCN IgY antibodies significantly increased PCN-treated Raji cell viability in a dose-dependent fashion (p<0.05). Conclusions: The results of the present study suggest that anti-PCN IgY antibodies may be protective on PCN-induced Raji cell death.
    MeSH terms: Animals; Chickens; Egg Yolk; Humans; Immunoglobulins; Infant; Lymphoma*; Pyocyanine
  11. ISBN: 978-967-11794-4-4
    Citation: Clinical Practice Guidelines: Management on Heart Failure, 4th Edition. Putrajaya: Ministry of Health, Malaysia; 2019

    Older versions: Third Edition (2014); Second Edition (2007); First Edition (2000)
    Keywords: CPG


    MeSH terms: Cardiology; Heart Failure; Humans; Malaysia; Guidelines as Topic
  12. Citation: Clinical Practice Guidelines: Management of Major Depressive Disorder (MDD), Second Edition. Putrajaya: Ministry of Health, Malaysia; 2019

    Quick Reference: http://www.acadmed.org.my/view_file.cfm?fileid=313
    Training Manual: http://www.acadmed.org.my/view_file.cfm?fileid=315
    Patient Information Leaflet: http://www.acadmed.org.my/view_file.cfm?fileid=327

    Older version:
    Citation: Clinical Practice Guidelines: Management of Major Depressive Disorder (MDD), First Edition. Putrajaya: Ministry of Health, Malaysia; 2007
    Keywords: CPG
    MeSH terms: Depression; Depressive Disorder, Major; Humans; Malaysia; Psychiatry; Guidelines as Topic
  13. Katayama A, Kume T, Ichihashi R, Nakagawa M
    Tree Physiol, 2019 06 01;39(6):1000-1008.
    PMID: 30976804 DOI: 10.1093/treephys/tpz022
    Limited knowledge about vertical variation in wood CO2 efflux (Rwood) is still a cause of uncertainty in Rwood estimates at individual and ecosystem scales. Although previous studies found higher Rwood in the canopy, they examined several tree species of similar size. In contrast, in the present study, we measured vertical variation in Rwood for 18 trees including 13 species, using a canopy crane for a more precise determination of the vertical variation in Rwood, for various species and sizes of trees in order to examine the factors affecting vertical variation in Rwood and thus, to better understand the effect of taking into account the vertical and inter-individual variation on estimates of Rwood at the individual scale. We did not find any clear pattern of vertical variation; Rwood increased significantly with measurement height for only one tree, while it decreased for two more trees, and was not significantly related with measurement height in 15 other trees. Canopy to breast height Rwood ratio was not related to diameter at breast height or crown ratio, which supposedly are factors affecting vertical variation in Rwood. On average, Rwood estimates at individual scale, considering inter-individual variation but ignoring vertical variation, were only 6% higher than estimates considering both forms of variation. However, estimates considering vertical variation, while ignoring inter-individual variation, were 13% higher than estimates considering both forms of variation. These results suggest that individual measurements at breast height are more important for estimating Rwood at the individual scale, and that any error in Rwood estimation at this scale, due to the absence of any more measurements along tree height, is really quite negligible. This study measured various species and sizes of trees, which may be attributed to no clear vertical variation because factors causing vertical variation can differ among species and sizes.
    MeSH terms: Borneo; Carbon Dioxide/metabolism*; Malaysia; Trees/growth & development; Trees/metabolism*; Wood/metabolism; Rainforest*
  14. Abd Fattah SYAS, Hariri F, Nambiar P, Abu Bakar Z, Abdul Rahman ZA
    Curr Med Imaging Rev, 2019;15(7):645-653.
    PMID: 32008512 DOI: 10.2174/1573405614666181012144745
    OBJECTIVE: To validate the accuracy of the mandibular canal region in 3D biomodel produced by using data obtained from Cone-Beam Computed Tomography (CBCT) of cadaveric mandibles.

    METHODS: Six hemi-mandible samples were scanned using the i-CAT CBCT system. The scanned data was transferred to the OsiriX software for measurement protocol and subsequently into Mimics software to fabricate customized cutting jigs and 3D biomodels based on rapid prototyping technology. The hemi-mandibles were segmented into 5 dentoalveolar blocks using the customized jigs. Digital calliper was used to measure six distances surrounding the mandibular canal on each section. The same distances were measured on the corresponding cross-sectional OsiriX images and the 3D biomodels of each dentoalveolar block.

    RESULTS: Statistically no significant difference was found when measurements from OsiriX images and 3D biomodels were compared to the "gold standard" -direct digital calliper measurement of the cadaveric dentoalveolar blocks. Moreover, the mean value difference of the various measurements between the different study components was also minimal.

    CONCLUSION: Various distances surrounding the mandibular canal from 3D biomodels produced from the CBCT scanned data was similar to that of direct digital calliper measurements of the cadaveric specimens.

    MeSH terms: Humans; Models, Anatomic; Reproducibility of Results; Imaging, Three-Dimensional; Cone-Beam Computed Tomography
  15. Meng LK, Khalil A, Ahmad Nizar MH, Nisham MK, Pingguan-Murphy B, Hum YC, et al.
    Curr Med Imaging Rev, 2019;15(10):983-989.
    PMID: 32008525 DOI: 10.2174/1573405615666190724101600
    BACKGROUND: Bone Age Assessment (BAA) refers to a clinical procedure that aims to identify a discrepancy between biological and chronological age of an individual by assessing the bone age growth. Currently, there are two main methods of executing BAA which are known as Greulich-Pyle and Tanner-Whitehouse techniques. Both techniques involve a manual and qualitative assessment of hand and wrist radiographs, resulting in intra and inter-operator variability accuracy and time-consuming. An automatic segmentation can be applied to the radiographs, providing the physician with more accurate delineation of the carpal bone and accurate quantitative analysis.

    METHODS: In this study, we proposed an image feature extraction technique based on image segmentation with the fully convolutional neural network with eight stride pixel (FCN-8). A total of 290 radiographic images including both female and the male subject of age ranging from 0 to 18 were manually segmented and trained using FCN-8.

    RESULTS AND CONCLUSION: The results exhibit a high training accuracy value of 99.68% and a loss rate of 0.008619 for 50 epochs of training. The experiments compared 58 images against the gold standard ground truth images. The accuracy of our fully automated segmentation technique is 0.78 ± 0.06, 1.56 ±0.30 mm and 98.02% in terms of Dice Coefficient, Hausdorff Distance, and overall qualitative carpal recognition accuracy, respectively.

  16. Ramli Hamid MT, Rahmat K, Hamid SA, Kirat Singh SK, Hooi TG
    Curr Med Imaging Rev, 2019;15(9):866-872.
    PMID: 32008533 DOI: 10.2174/1573405614666180627101520
    BACKGROUND: Breast cancer is the commonest cancer affecting Malaysian women, accounting for an estimated 30% of all new cancer diagnosed annually. Improvements in breast cancer management have increased the breast cancer survival rate in Malaysia. Clinical and radiological surveillance of the treated breast is vital, as early detection of recurrence improves patient's survival rate.

    DISCUSSION: As surgery and radiotherapy alter the appearance of the breasts, distinguishing between recurrence and benign post-surgical changes can be challenging radiologically due to overlapping features. Despite this, differentiation between these two entities is usually possible by recognizing characteristic features of post-treatment sequelae and the evolution of the appearance of the conservatively treated breast by comparing interval findings on serial studies.

    CONCLUSION: This pictorial review aims to describe the typical and unusual features of post-treated breasts in the multimodality imaging workup of an established breast care centre in a teaching hospital in Malaysia.

    MeSH terms: Breast Neoplasms/surgery*; Female; Humans; Postoperative Period; Multimodal Imaging*
  17. Muhammad-Azam F, Nur-Fazila SH, Ain-Fatin R, Mustapha Noordin M, Yimer N
    Vet World, 2019 Nov;12(11):1682-1688.
    PMID: 32009746 DOI: 10.14202/vetworld.2019.1682-1688
    Background and Aim: Laboratory mice are widely used as a research model to provide insights into toxicological studies of various xenobiotic. Acetaminophen (APAP) is an antipyretic and analgesic drug that is commonly known as paracetamol, an ideal hepatotoxicant to exhibit centrilobular necrosis in laboratory mice to resemble humans. However, assessment of histopathological changes between mouse strains is important to decide the optimal mouse model used in APAP toxicity study. Therefore, we aim to assess the histomorphological features of APAP-induced liver injury (AILI) in BALB/C and Institute of Cancer Research (ICR) mice.

    Materials and Methods: Twenty-five ICR mice and 20 BALB/C mice were used where five animals as control and the rest were randomly divided into four time points at 5, 10, 24 and 48 hours post-dosing (hpd). They were induced with 500 mg/kg APAP intraperitoneally. Liver sections were processed for hematoxylin-eosin staining and histopathological changes were scored based on grading methods.

    Results: Intense centrilobular damage was observed as early as 5 hpd in BALB/C as compared to ICR mice, which was observed at 10 hpd. The difference of liver injury between ICR and BALB/C mice is due to dissimilarity in the genetic line-up that related to different elimination pathways of APAP toxicity. However, at 24 hpd, the damage was markedly subsided and liver regeneration had taken place for both ICR and BALB/C groups with evidence of mitotic figures. This study showed that normal liver architecture was restored after the clearance of toxic insult.

    Conclusion: AILI was exhibited earlier in BALB/C than ICR mice but both underwent liver recovery at later time points.

    MeSH terms: Acetaminophen; Analgesics; Animals; Eosine Yellowish-(YS); Hematoxylin; Humans; Liver Regeneration; Mice, Inbred BALB C; Mice, Inbred ICR; Staining and Labeling; Focal Nodular Hyperplasia; Mice; Antipyretics
  18. Mohd-Aris A, Muhamad-Sofie MHN, Zamri-Saad M, Daud HM, Ina-Salwany MY
    Vet World, 2019 Nov;12(11):1806-1815.
    PMID: 32009760 DOI: 10.14202/vetworld.2019.1806-1815
    Fish diseases are often caused either by bacteria, viruses, fungi, parasites, or a combination of these pathogens. Of these, bacterial fish diseases are considered to be a major problem in the aquaculture industry. Hence, the prevention of such diseases by proper vaccination is one of the integral strategies in fish health management, aimed at reducing the fish mortality rate in the aquaculture farms. Vaccination offers an effective yet low-cost solution to combat the risk of disease in fish farming. An appropriate vaccination regime to prevent bacterial diseases offers a solution against the harmful effects of antibiotic applications. This review discusses the role of live-attenuated vaccine in controlling bacterial diseases and the development of such vaccines and their vaccination strategy. The current achievements and potential applications of live-attenuated and combined vaccines are also highlighted. Vaccine development is concluded to be a demanding process, as it must satisfy the requirements of the aquaculture industry.
    MeSH terms: Animals; Anti-Bacterial Agents; Bacteria; Fish Diseases; Fisheries; Fungi; Parasites; Vaccination; Vaccines, Attenuated; Viruses; Aquaculture; Vaccines, Combined
  19. Yong SJ, Tong T, Chew J, Lim WL
    Front Neurosci, 2019;13:1361.
    PMID: 32009871 DOI: 10.3389/fnins.2019.01361
    The accumulating knowledge of the host-microbiota interplay gives rise to the microbiota-gut-brain (MGB) axis. The MGB axis depicts the interkingdom communication between the gut microbiota and the brain. This communication process involves the endocrine, immune and neurotransmitters systems. Dysfunction of these systems, along with the presence of gut dysbiosis, have been detected among clinically depressed patients. This implicates the involvement of a maladaptive MGB axis in the pathophysiology of depression. Depression refers to symptoms that characterize major depressive disorder (MDD), a mood disorder with a disease burden that rivals that of heart diseases. The use of probiotics to treat depression has gained attention in recent years, as evidenced by increasing numbers of animal and human studies that have supported the antidepressive efficacy of probiotics. Physiological changes observed in these studies allow for the elucidation of probiotics antidepressive mechanisms, which ultimately aim to restore proper functioning of the MGB axis. However, the understanding of mechanisms does not yet complete the endeavor in applying probiotics to treat MDD. Other challenges remain which include the heterogeneous nature of both the gut microbiota composition and depressive symptoms in the clinical setting. Nevertheless, probiotics offer some advantages over standard pharmaceutical antidepressants, in terms of residual symptoms, side effects and stigma involved. This review outlines antidepressive mechanisms of probiotics based on the currently available literature and discusses therapeutic potentials of probiotics for depression.
  20. Tan K, Zhang H, Lim LS, Ma H, Li S, Zheng H
    Front Immunol, 2019;10:3041.
    PMID: 32010132 DOI: 10.3389/fimmu.2019.03041
    Carotenoids are biologically active pigments that are well-known to enhance the defense and immunity of the vertebrate system. However, in invertebrates, the role of carotenoids in immunity is not clear. Therefore, this study aims to review the scientific evidence for the role of carotenoids in invertebrate immunization. From the analysis of published literatures and recent studies from our laboratory, it is obvious that carotenoids are involved in invertebrate immunity in two ways. On the one hand, carotenoids can act as antioxidant enzymes to remove singlet oxygen, superoxide anion radicals, and hydroxyl radicals, thereby reducing SOD activity and reducing the cost of immunity. In some organisms, carotenoids have been shown to promote SOD activity by up-regulating the expression of the ZnCuSOD gene. Carotenoids, on the other hand, play a role in the expression and regulation of many genes involved in invertebrate immunity, including thioredoxins (TRX), peptidoglycan recognition receptor proteins (PGRPs), ferritins, prophenoloxidase (ProPO), vitellogenin (Vg), toll-like receptor (TLRs), heat shock proteins (HSPs), and CuZnSOD gene. The information in this review is very useful for updating our understanding of the progress of carotenoid research in invertebrate immunology and to help identify topics for future topics.
    MeSH terms: Animals; Antioxidants; Carotenoids; Carrier Proteins; Catechol Oxidase; Ferritins; Heat-Shock Proteins; Peptidoglycan; Pigments, Biological; Superoxides; Thioredoxins; Vitellogenins; Hydroxyl Radical; Singlet Oxygen
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